Robotic versus open level III-IV inferior vena cava thrombectomy: A multicenter, retrospective, propensity-matched analysis.

Background: The safety and efficacy of robotic inferior vena cava thrombectomy (IVCTE) for level III-IV thrombus with a comparison to open IVCTE is still unclear. This study aimed to compare robotic vs open IVCTE for renal tumors with level III-IV tumor thrombus.

Materials And Methods: We performed a retrospective analysis of patients who underwent R-IVCTE or O-IVCTE in four academic tertiary centers between 2015 and 2023. Propensity score-matching analysis was performed. Perioperative data and prognosis were reviewed. Progression-free survival and overall survival were analyzed by Kaplan-Meier survival curve, and comparison between groups was performed by log-rank test.

Results: A total of 34 and 70 patients underwent R-IVCTE and O-IVCTE, respectively. After matching, baseline characteristics were comparable (30 vs 30 patients). Of the matched cohorts, robotic procedures were associated with longer operative time (508 vs 322 min; p < 0.001), lower rate of cardiopulmonary bypass (33.3 % vs 66.7 %; p = 0.010), longer ICU stay (5 vs 2 days, p = 0.001), shorter postoperative hospital stay (10 vs 13 days, p = 0.021). Patients undergoing R-IVCTE had a higher level of serum aminotransferase and aspartate aminotransferase than those undergoing O-IVCTE at 1-2 days after surgery, and the difference had disappeared at 1 week after surgery. No difference was observed between the two approaches regarding estimated blood loss, complications, pathological variables and oncological outcomes.

Conclusions: R-IVCTE can be feasible and safe in selected cases of renal tumors with level III-IV tumor thrombus, which may achieve similar perioperative and oncological outcomes compared to O-IVCTE.